Cor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale.
Right-sided heart failure
High blood pressure in the arteries of the lungs is called pulmonary hypertension. It is the most common cause of cor pulmonale.
In people who have pulmonary hypertension, changes in the small blood vessels inside the lungs can lead to increased blood pressure in the right side of the heart. This makes it harder for the heart to pump blood to the lungs. If this high pressure continues, it puts a strain on the right side of the heart. That strain can cause cor pulmonale.
Chronic lung conditions that cause low blood oxygen levels in the blood over a long time can also lead to cor pulmonale. A few of these are:
- Chronic obstructive pulmonary disease (COPD)
- Chronic blood clots in the lungs
- Cystic fibrosis (CF)
- Scarring of the lung tissue (interstitial lung disease)
- Severe curving of the upper part of the spine (kyphoscoliosis)
- Obstructive sleep apnea, which causes stops in breathing because of airway inflammation
Shortness of breath or light-headedness during activity is often the first symptom of cor pulmonale. You may also have a fast heartbeat and feel like your heart is pounding.
Over time, symptoms occur with lighter activity or even while you are at rest. Some symptoms you may have are:
- Fainting spells during activity
- Chest discomfort, usually in the front of the chest
- Chest pain
- Swelling of the feet or ankles
- Symptoms of lung disorders, such as wheezing or coughing
- Lips and fingers that turn blue (cyanosis)
Exams and Tests
Your health care provider will perform a physical exam. This may show:
- Fluid buildup in your belly
- Abnormal heart sounds
- Bluish skin
- Liver swelling
- Swelling of the neck veins, which is a sign of high pressure in the right side of the heart
- Ankle swelling
These tests may help diagnose cor pulmonale:
- Blood antibody tests
- Blood test to check for a substance called brain natriuretic peptide (BNP)
- Chest x-ray
- CT scan of the chest, with or without an injection of a contrast fluid (dye)
- Echocardiogram (ECG or EKG)
- Lung biopsy (rarely done)
- Measurement of blood oxygen by checking arterial blood gas (ABG)
- Pulmonary (lung) function tests
- Right heart catheterization
- Ventilation and perfusion scan of the lungs (V/Q scan)
The goal of treatment is to control symptoms. It is important to treat medical problems that cause pulmonary hypertension, because they can lead to cor pulmonale.
Many treatment options are available. Your doctor will decide which medicine is best for you. In general, the cause of your cor pulmonale will determine which treatment you receive.
If your doctor prescribes medicines, you may take them by mouth (oral), receive them through a tube that goes into a vein (intravenous or IV), or breathe them in (inhaled). You will be closely monitored during treatment to watch for side effects and to see how well the medicine works for you. Never stop taking your medicines without first talking to your doctor.
Other treatments may include:
- Blood thinners to reduce the risk of blood clots
- Oxygen therapy at home
- A lung or heart-lung transplant, if medicine does not work
Important tips to follow:
- Avoid strenuous activities and heavy lifting.
- Avoid traveling to high altitudes.
- Get a yearly flu vaccine, as well as other vaccines, such as the pneumonia vaccine.
- If you smoke, stop.
- Use oxygen if your doctor prescribes it.
- Do not get pregnant (women).
How well you do depends on the cause of your cor pulmonale.
As your illness gets worse, you will need to make changes to your home so that you can manage as well as possible. You will also need help around your house.
Cor pulmonale may lead to:
- Life-threatening shortness of breath
- Severe fluid buildup in your body
When to Contact a Medical Professional
Call your doctor or nurse if you have shortness of breath or chest pain.
Avoid cigarette smoking to help prevent lung disease, because lung disease can lead to cor pulmonale.
McGlothlin D, De Marco T. Cor pulmonale. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 56.
Massie BM. Heart failure: pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 58.
Reviewed By: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.